| Certificate Number | 78 | | Date Issued |
| Child Given Name | R.W. |
Emerson | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 19 Nov 1888 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Clinton |
Emerson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 29 | Father's Age |
| Mother's Given Name | Sarah | Hallowell | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 21 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |